Provider Demographics
NPI:1831580166
Name:ARDEMAIK SURGICAL SERVICES
Entity type:Organization
Organization Name:ARDEMAIK SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELSIDA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:PEREZ TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-653-2924
Mailing Address - Street 1:10935 ALMEDA GENOA RD
Mailing Address - Street 2:P.O. BOX 34551
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-9998
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:
Practice Address - Street 1:10935 ALMEDA GENOA RD
Practice Address - Street 2:POB 34551
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-9998
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00445363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00445OtherTEXAS MEDICAL BOARD